Silencing Distractions in Radiology through Mindfulness Meditation

Mindfulness meditation can help radiologists stay focused and precise.

By Donald J. Flemming, M.D. , Penn State Hershey Medical Center.

Focus and precision are central to accurate diagnostic readings. But how can we as radiologists maintain these essential qualities amidst the growing volume of readings and interruptions? For me, the answer lies in the daily practice of mindfulness mediation.

I am a practicing musculoskeletal radiologist at Penn State Hershey Radiology. Since I started here 13 years ago, the volume of reads and the pressures of Relative Value Units (RVUs) and report turnaround time have increased dramatically. When I first joined the center, faculty only read about 10 percent of the imaging studies. The majority were read by residents, who received feedback from faculty. Since then, our volume of exams has gotten so high that now faculty dictate 70 percent of the exams independently. This month alone, I will interpret over 2,000 exams and a total of about 18,000 cases this year. I suspect that other radiologists have similar numbers and the same pressure.

Mindfulness meditation can help radiologists stay focused on diagnostic reading.

With the increased volume comes increased requests for information – often in the form of interruptions. Also, technology advances bring with them increased distraction. Voice recognition is a wonderful tool for faster report turnaround time, but the onus is on me to manage the tool. Additionally, my focus is fragmented each time I need to review the electronic medical record, answer a clinical question from a referring provider, or to page someone.

So how can we as radiologists come back to a place of focus and precision in order to give an exam our best diagnosis? What can we do to be as thorough on our reads at 5 p.m. as we were at 8 a.m. before we were fatigued from a long day? By re-centering through mediation.

Mindfulness meditation helps reset my mental focus for complex reads

I have been practicing meditation for about 30 years, and I find it extremely useful in my practice. There are many forms of meditation; however I practice “mindfulness mediation”. Simply stated, it involves sitting, standing, or laying comfortably and focusing on your breathing, and then bringing your mind’s attention to the present – blocking out our whirlwind of thoughts and the distractions of the environment.

Being in a state of mindfulness is especially important for reading complex cases. Like many experienced radiologists, I can do an unconscious assessment on a non-complex case, like a normal chest X-ray, within about 300 milliseconds. Our Type 1 thinking, which resides in the brain stem, quickly lets us assess whether something is abnormal.

How can we as radiologists come back to a place of focus and precision in order to give an exam our best diagnosis?

However, interpreting imaging studies requires our higher level Type 2 thinking. Meditation helps me reset my mental state and slow down for these complicated reads. As a result, I am more deliberate as I step through my mental checklist, taking advantage of past errors, and making sure I methodically review every image in the study. It helps me slow down and take a second look at what seems like a straightforward injury, such as a wrist fracture. Is there an abnormality at the edge of that image? I believe the practice helps relieve some of my fatigue and helps me to do my best diagnosis even at the end of a long day.

My experience with meditation also makes me aware of when I am becoming agitated or anxious, perhaps as a result of looking at my worklist or because I have been interrupted repeatedly. When I feel that anxiety – which I know will cloud my focus – I take a moment to pause, breath, and get re-centered into a state of mindfulness. I won’t even attempt to take a second look at a case until I’ve taken these steps to clear the distractions vying for attention in my own head. I do these one- to two-minute interventions throughout the day. Because of my extensive practice of meditation, I am able to clear my mind and focus better within a few minutes. For beginners, it will likely take longer a period of time to clear their minds.

In addition to mindfulness meditation, I make it a point to walk away from my screen briefly at about 40- to 50-minute intervals. I also do longer guided meditations in the morning.

Meditation can help relieve stress for new and veteran radiologists

I introduce all my new students to the practice of meditation. I give them time to review on online course on meditation during the week they are on rotation with me. Also, I provide them with available resources if they want to pursue the discipline further. (You can see my list at the end of this blog.)

I don’t force it on them, but I want them to be aware of it as another tool available to help them. Residency is a very stressful time in a physician’s life. Residents have anxiety about performing new procedures and have not yet learned how to manage uncertainty and failure. In addition to working and learning, personal responsibilities of being a spouse or parent add additional pressures.

Their reactions vary. Some students are incredibly receptive; others are intellectually intrigued but won’t practice it. And quite a few are surprised when presented with the science behind the practice of meditation.

Like many of my peers, I entered this profession because I want to help patients. We are constantly trying to read better or faster because somewhere, an anxious patient is waiting for the results of the exam. But sometimes we forget to take care of ourselves, too. For me, mindfulness meditation in conjunction with regular exercise and good sleep hygiene is an effective way to relieve my own stress, which in turn helps me serve my patients better.

Donald J. Flemming, M.D. is a Professor of Radiology and Orthopedics & Rehabilitation, Vice Chair for Education and the G. Victor Rohrer Professor for Radiologic Education at Penn State Hershey Medical Center. He earned a Bachelor of Science degree from Rensselaer Polytechnic Institute in 1981and his Doctor of Medicine degree from the State University of New York at Buffalo in 1985. Dr. Flemming completed his radiology residency training at the National Naval Medical Center and fellowship education in Musculoskeletal Radiology at the Armed Forces Institute of Pathology. Dr. Flemming had been a residency program director for 18 years and has a strong interest in medical education.

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